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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002550
Report Date: 05/17/2022
Date Signed: 05/17/2022 02:29:36 PM


Document Has Been Signed on 05/17/2022 02:29 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:CHERI MANORFACILITY NUMBER:
306002550
ADMINISTRATOR:ARIEL REYESFACILITY TYPE:
740
ADDRESS:1160 CHERI DRIVETELEPHONE:
(562) 690-5700
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:6CENSUS: 5DATE:
05/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Marisa Acerbo and George FongTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Kathrina Chin conducted an unannounced required annual inspection in this facility. LPA met with Marisa Acerbo, care staff and George Fong, Administrator and stated the purpose of this visit.

LPA Chin was granted entry after completing the COVID-19 screening procedure. LPA toured the interior and exterior portions of the facility. Rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke, carbon monoxide and auditory exit alarms were tested to be operational. Bathrooms were observed to be in good repair; and provided with grab bars and non-skid floor mats. Hot water was measured was observed to be 105.6 degrees Fahrenheit in a resident bathroom. Facility met the minimum two day perishable and seven day non-perishable food stock requirements. Medications, cleaning supplies and sharp items were inaccessible to residents in care. Fire extinguishers were mounted and charged. For the exterior portion, the facility had several patio furniture and umbrellas for shade and grounds were free of tripping hazards. LPA observed the emergency disaster and evacuation plans. Facility has back-up emergency food and water supply. The facility has sufficient PPE supplies.

LPA Chin reviewed the COVID 19 mitigation plan of the facility.

For this visit, there are no deficiencies cited this review as per Title 22 of the California Code of Regulations.

LPA Chin conducted an exit interview with George Fong, Administrator and copy of this report was left in the facility
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2838
LICENSING EVALUATOR NAME: Kathrina ChinTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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